Skip to main content Accessibility help
×
Hostname: page-component-77f85d65b8-7lfxl Total loading time: 0 Render date: 2026-04-13T13:38:07.443Z Has data issue: false hasContentIssue false

34 - Pain management

from Part IV - Complications and supportive care

Published online by Cambridge University Press:  01 July 2010

By
Alberto J. de Armendi  and
Doralina L. Anghelescu
Edited by
Ching-Hon Pui
Alberto J. de Armendi
Affiliation:
Chief and Member, Division of Anesthesiology St. Jude Children's Research Hospital, Memphis, TN, USA
Doralina L. Anghelescu
Affiliation:
Associate Member, Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, TN, USA
Ching-Hon Pui
Affiliation:
St. Jude Children's Research Hospital, Memphis
Get access

Summary

Principles of pain management for children with cancer

In identifying and treating pain in children with cancer, one must keep in mind the complexity of pain as a physiological, psychological, and social phenomenon. The etiology of pain in the cancer patient is diverse. Children with cancer experience pain associated with the disease, pain caused by procedures to establish a diagnosis and monitor the disease, and pain related to therapeutic interventions (postoperative pain or pain related to chemotherapy or radiotherapy). Because of the multitude and complexity of factors involved in the pathogenesis of pain in children with cancer, the diagnostic and therapeutic strategies for pain management need to be individualized to the particular needs of each patient. The treatment plan most often includes multiple pharmacologic and nonpharmacologic interventions delivered by a multidisciplinary team that includes pediatricians, oncologists, anesthesiologists, nurses, psychologists, child life specialists, and physical therapists. The principles of pain management for children with cancer are presented in Table 34.1.

Assessment of pain

Before pain can be successfully managed or controlled, it must first be assessed using tools that are age appropriate and well suited to the clinical situation. In assessing pain, the health care provider should always assume that the child's report of pain is valid. Self-report is the gold standard for assessment of pain. For infants, toddlers, or children who cannot self-report, the FLACC (face, legs, activity, cry, consolability) Scale is recommended (Table 34.2) and has received clinical validation. Each component is scored separately, and these scores are summed to determine the FLACC score.

Information

Type
Chapter
Information
Childhood Leukemias , pp. 850 - 857
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Merkel, S. I., Voepel-Lewis, T., Shayevitz, J. R., et al.The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs, 1997; 23: 293–7.Google ScholarPubMed
Manworren, R. C. & Hynan, L. S.Clinical validation of FLACC: preverbal patient pain scale. Pediatr Nurs, 2003; 29: 140–6.Google ScholarPubMed
Wong, D. L., Hockenberry-Eaton, M., Winkelstein, M. L., et al.Whaley & Wong's Nursing Care of Infants and Children, 6th edn. (St. Louis, MO: Mosby, 1999), p. 2040.Google Scholar
Hicks, C. L., Baeyer, C. L. von, Spafford, P. A., et al.The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain, 2001; 93: 173–83.CrossRefGoogle Scholar
Golianu, B., Krane, E. J., Galloway, K. S., et al.Pediatric acute pain management. Pediatr Clin North Am, 2000; 47: 559–87.CrossRefGoogle ScholarPubMed
Litalien, C. & Jacqz-Aigrain, E.Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs, 2001; 3: 817–58.CrossRefGoogle ScholarPubMed
Anand, K. J. & Ingraham, J.Pediatric Tolerance, dependence, and strategies for compassionate withdrawal of analgesics and anxiolytics in the pediatric ICU. Critical Care Nurse, 1996; 16: 87–93.Google ScholarPubMed
Meissner, W., Schmidt, U., Hartmann, M., et al.Oral naloxone reverses opioid-associated constipation. Pain, 2000; 84: 105–9.CrossRefGoogle ScholarPubMed
Rusy, L. M., Troshynski, T. J., & Weisman, S. J.Gabapentin in phantom limb pain management in children and young adults. Report of seven cases. J Pain Symptom Manage, 2001; 21: 78–82.CrossRefGoogle Scholar
Massey, G. V., Pedigo, S., Dunn, N. L., et al.Continuous lidocaine infusion for the relief of refractory malignant pain in a terminally ill pediatric cancer patient. J Pediatr Hematol Oncol, 2002; 24: 566–8.CrossRefGoogle Scholar
Weisman, S. J., Bernstein, B., & Schechter, N. L.Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med, 1998; 152: 147–9.CrossRefGoogle ScholarPubMed
Stuber, M. L., Christakis, D. A., Houskamp, B., et al.Posttrauma symptoms in childhood leukemia survivors and their parents. Psychosomatics, 1996; 37: 254–61.CrossRefGoogle ScholarPubMed
Jacobsen, P. B., Manne, S. L., Gorfinkle, K., et al.Analysis of child and parent behavior during painful medical procedures. Health Psychol, 1990; 9: 559–76.CrossRefGoogle ScholarPubMed
LeBaron, S. & Zeltzer, L.Assessment of acute pain and anxiety in children and adolescents by self-reports, observer reports, and a behavior checklist. J Consult Clin Psychol, 1984; 52: 729–38.CrossRefGoogle Scholar
Stanski, D. R. & Shafer, S. L.Quantifying anesthetic drug interaction. Implications for drug dosing. Anesthesiology, 1995; 83: 1–5.CrossRefGoogle ScholarPubMed
Oyama, T. & Wakayama, S.The endocrine responses to general anesthesia. Int Anesthesiol Clin, 1998; 26: 176–81.CrossRefGoogle Scholar
Bailey, P. L., Egan, T. D., & Stanley, T. H. Intravenous opioid anesthetics. In , R. D. Miller, ed., Anesthesia, 5th edn. (Philadelphia, PA: Churchill Livingstone, 2000), pp. 302–3.Google Scholar
Krane, E. Oncology procedures. In , M. Yaster, , E. J. Krane, , R. F. Kaplan, , C. J. Coté, & , D. G. Lappe, eds., Pediatric Pain Management and Sedation Handbook (St Louis, MO: Mosby, 1997), pp. 481–8.Google Scholar
Hockenberry, M. J. & Bologna-Vaughan, S. B.Preparation for intrusive procedures using noninvasive techniques in children with cancer: state of the art versus new trends. Cancer Nurs, 1985; 8: 97–102.CrossRefGoogle Scholar
Broome, M. E., Richtsmeier, A., Maikler, V., et al.Pediatric pain practices: a national survey of health professionals. J Pain Symptom Manage, 1996; 11: 312–20.CrossRefGoogle ScholarPubMed
Pietrement, C., Salomon, R., Monceaux, F., et al.Analgesia with oxygen-nitrous oxide mixture during percutaneous renal biopsy in children. Arch Pediatr, 2001; 8: 145–9.Google ScholarPubMed
Annequin, D., Carbajal, R., Chauvin, P., et al.Fixed 50% nitrous oxide oxygen mixture for painful procedures: a French survey. Pediatrics, 2000; 105: E47.CrossRefGoogle ScholarPubMed
Fulton, B. & Sorkin, E. M. Propofol. An overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs, 1995; 50: 636–57.CrossRefGoogle Scholar
Bryson, H. M., Fulton, B. R., & Faulds, D. Propofol. An update on its use in anaesthesia and conscious sedation. Drugs, 1995; 50: 513–59.CrossRefGoogle ScholarPubMed
Smith, I., White, P. F., Nathanson, M., et al.Propofol: an update on its clinical use. Anesthesiology, 1994; 81: 1005–43.Google ScholarPubMed
Hannallah, R. S., Baker, S. B., Casey, W., et al.Propofol: effective dose and induction characteristics in unpremedicated children. Anesthesiology, 1991; 74: 217–19.CrossRefGoogle ScholarPubMed
Reves, J. G., Glass, P. S. A., & Lubarsky, D. A. Nonbarbiturate intravenous anesthetics. In , R. D. Miller, ed. Anesthesia, 5th edn. (Philadelphia, PA: Churchill Livingstone, 2000), pp. 251–4.Google Scholar
Jayabose, S., Levendoglu-Tugal, O., Giamelli, J., et al.Intravenous anesthesia with propofol for painful procedures in children with cancer. J Pediatr Hematol Oncol, 2001; 23: 290–3.CrossRefGoogle ScholarPubMed
Hertzog, J. H., Dalton, H. J., Anderson, B. D., et al.Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children. Pediatrics, 2000; 106: 742–7.CrossRefGoogle ScholarPubMed
Coté, C. J., Lugo, R. A., & Ward, R. M. Pharmacokinetics and pharmacology of drugs in children. In , C. J. Cote, , I. D. Todres, , N. G. Goudsouzian, & , J. F. Ryan, eds., A Practice of Anesthesia for Infants and Children, 3rd edn. (Philadelphia, PA: W. B. Saunders, 2001), pp. 148–9.Google Scholar
Maunuksela, E. L. & Korpela, R.Double-blind evaluation of a lignocaine-prilocaine cream (EMLA) in children. Effect on the pain associated with venous cannulation. Br J Anaesth, 1986; 58: 1242–5.CrossRefGoogle ScholarPubMed
Soliman, I. E., Broadman, L. M., Hannallah, R. S., et al.Comparison of the analgesic effects of EMLA (eutectic mixture of local anesthetics) to intradermal lidocaine infiltration prior to venous cannulation in unpremedicated children. Anesthesiology, 1988; 68: 804–6.CrossRefGoogle ScholarPubMed
Halperin, D. L., Koren, G., Attias, D., et al.Topical skin anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children. Pediatrics, 1989; 84: 281–4.Google ScholarPubMed
Paut, O., Calmejane, C., Delorme, J., et al.EMLA versus nitrous oxide for venous cannulation in children. Anesth Analg, 2001; 93: 1590–3.CrossRefGoogle ScholarPubMed
Cordoni, A. & Cordoni, L. E.Eutectic mixture of local anesthetics reduces pain during intravenous catheter insertion in the pediatric patient. Clin J Pain, 2001; 17: 115–18.CrossRefGoogle ScholarPubMed
Juarez Gimenez, J. C., Oliveras, M., Hidalgo, E., et al.Anesthetic efficacy of eutectic prilocaine-lidocaine cream in pediatric oncology patients undergoing lumbar puncture. Ann Pharmacother, 1996; 30: 1235–7.Google ScholarPubMed
Eichenfield, L. F., Funk, A., Fallon-Friedlander, S., et al.A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics, 2002; 109: 1093–6.CrossRefGoogle ScholarPubMed
Mercadante, S.Neuraxial techniques for cancer pain: an opinion about unresolved therapeutic dilemmas. Reg Anesth Pain Med, 1999; 24: 74–83.Google ScholarPubMed
Nichols, D. G., Yaster, M., Lynn, A. M., et al.Disposition and respiratory effects of intrathecal morphine in children. Anesthesiology, 1993; 79: 733–8.Google ScholarPubMed
Collins, J. J., Grier, H. E., Kinney, H. C., et al.Control of severe pain in children with terminal malignancy. J Pediatr, 1995; 126: 653–7.CrossRefGoogle ScholarPubMed
Aram, L., Krane, E. J., Kozloski, L. J., et al.Tunneled epidural catheters for prolonged analgesia in pediatric patients. Anesth Analg, 2001; 92: 1432–8.CrossRefGoogle ScholarPubMed
Byers, K., Axelrod, P., Michael, S., et al.Infections complicating tunneled intraspinal catheter systems used to treat chronic pain. Clin Infect Dis, 1995; 21: 403–8.CrossRefGoogle ScholarPubMed
Du Pen, S. L., Peterson, D. G., Williams, A., et al.Infection during chronic epidural catheterization: diagnosis and treatment. Anesthesiology, 1990; 73: 905–9.CrossRefGoogle ScholarPubMed
Galloway, K., Staats, P. S., & Bowers, D. C.Intrathecal analgesia for children with cancer via implanted infusion pumps. Med Pediatr Oncol, 2000; 34: 265–7.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Naguib, M., Sharif, A. M., Seraj, M., et al.Ketamine for caudal analgesia in children: comparison with caudal bupivacaine. Br J Anaesth, 1991; 67: 559–64.CrossRefGoogle ScholarPubMed
Semple, D., Findlow, D., Aldridge, L. M., et al.The optimal dose of ketamine for caudal epidural blockade in children. Anaesthesia, 1996; 51: 1170–2.CrossRefGoogle ScholarPubMed
Staats, P. S. & Kost-Byerly, S.Celiac plexus blockade in a 7-year-old child with neuroblastoma. J Pain Symptom Manage, 1995; 10: 321–4.CrossRefGoogle Scholar
Chen, E., Joseph, M. H., & Zeltzer, L. K.Behavioral and cognitive interventions in the treatment of pain in children. Pediatr Clin North Am, 2000; 47: 513–25.CrossRefGoogle ScholarPubMed
Kuppenheimer, W. G. & Brown, R. T.Painful procedures in pediatric cancer. A comparison of interventions. Clin Psychol Rev, 2002; 22: 753–86.CrossRefGoogle ScholarPubMed
Christensen, J. & Fatchett, D.Promoting parental use of distraction and relaxation in pediatric oncology patients during invasive procedures. J Pediatr Oncol Nurs, 2002; 19: 127–32.CrossRefGoogle ScholarPubMed
Kleiber, C. & Harper, D. C.Effects of distraction on children's pain and distress during medical procedures: a meta-analysis. Nurs Res, 1999; 48: 44–9.CrossRefGoogle ScholarPubMed

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Pain management
    • By Alberto J. de Armendi, Chief and Member, Division of Anesthesiology St. Jude Children's Research Hospital, Memphis, TN, USA, Doralina L. Anghelescu, Associate Member, Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, TN, USA
  • Edited by Ching-Hon Pui
  • Book: Childhood Leukemias
  • Online publication: 01 July 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511471001.035
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Pain management
    • By Alberto J. de Armendi, Chief and Member, Division of Anesthesiology St. Jude Children's Research Hospital, Memphis, TN, USA, Doralina L. Anghelescu, Associate Member, Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, TN, USA
  • Edited by Ching-Hon Pui
  • Book: Childhood Leukemias
  • Online publication: 01 July 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511471001.035
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Pain management
    • By Alberto J. de Armendi, Chief and Member, Division of Anesthesiology St. Jude Children's Research Hospital, Memphis, TN, USA, Doralina L. Anghelescu, Associate Member, Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, TN, USA
  • Edited by Ching-Hon Pui
  • Book: Childhood Leukemias
  • Online publication: 01 July 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511471001.035
Available formats
×